My laminates are being denied - Help!

Whenever I submit a claim for porcelein laminates, the claim gets denied. How can I prevent this?

Dr G, Pa

Most dental plans have cosmetic exclusions so if that is the reason you're placing laminates, they will continue to be denied. It's contractual.

If the teeth need structural support, then your documentation is not convincing the company's dental consultants that they are needed. Since a fair number of laminates are placed for cosmetics, you must provide solid proof that these restorations are needed.

If large restorations are present with recurrent decay (large fillings without decay are usually not sufficient reasons for replacement) make sure your x-rays reflect that.

If the necessity is not evident in the radiographs, then a photograph can help. (Discolored fillings without decay are also not a reason for replacement).

If you've replaced the restoration in that tooth several times and it's time to step up to a more comprehensive one, include a copy of the patient's charts documenting your more conservative attempts.

And if all else fails, include a narrative along with the film and photo. But remember that a narrative alone will usually not convince a consultant of necessity.

Remember that craze lines will not usually justify restoration replacement in the eyes of most consultants.

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